title: New classification of anomalous venous drainage using caverno-computed tomography in men with erectile dysfunction.
abstract: BACKGROUND
  Venous leak evaluation remains a challenge in many ED patients. Adequate anatomical evaluation may help with optimizing therapeutic strategies.
  
  
  OBJECTIVE
  Propose a new classification of venous leakage using multidetector computed tomography (MDCT) cavernography, after contrast media intracavernous injection (ICI), under pharmacological stimulation.
  
  
  METHODS
  Thirty-eight patients gave informed consent for the study: 34 complained of ED, unsatisfied with treatment and suspected to have cavernovenous leak; four having morphological anomalies and needing surgery. Patient's clinical history, including age, vascular risk factors, penile nitric oxide release test, Doppler ultrasound and previous treatments were evaluated. MDCT consisted in: 1-ICI of 1 mL of vasoactive medications containing papaverine, chlorydrate (20 mg), urapidil chlorydrate (2.75 mg) and alprostadil (10 mcg); 2-ICI of 20-60 cc of diluted contrast media (1/3) using 20 cc of Ioprimide (300 mg/mL); 3-Spiral MDCT acquisition and three-dimensional volume rendering.
  
  
  METHODS
  Erection degree was assessed using the erection hardness score (EHS); venous drainage was analyzed and deep, superficial veins (SVs), and caverno-spongious communications identified. MDCT findings were compared with clinical data.
  
  
  RESULTS
  The deep dorsal vein (DDV) was opacified in 58% of patients and the SV in 50%. Cavernospongious communications were visible in 18.4%. Sixteen percent presented no visible drainage. A new classification of venous drainage anomalies is proposed: A-No visible drainage (N = 8); B-DDV and preprostatic plexus opacification (N = 11); C-Exclusive SV opacification (N = 10); D-Opacification of both SV and DDV (N = 9). All patients (with one exception) in group A quoted 4 at the EHS vs. none in the others groups (P < 0.0001, exact Fisher test). One patient in group A needed venous drainage due to prolonged erection.
  
  
  CONCLUSIONS
  MDCT after ICI contrast media was able to differentiate between various venous pathways in men with venous origin ED, leading to a new anatomical classification. Absence of leakage was associated with normal erection under pharmacological stimulation.
authors.affiliation: Centre d'Explorations et Traitements de l'Impuissance, Paris, France. rvirag@wanadoo.fr
authors.forename: Ronald
authors.initials: R
authors.lastname: Virag
authors.forename: Jean François
authors.initials: JF
authors.lastname: Paul
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D006801:Humans; D018783:Impotence, Vasculogenic / Q000145:classification* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media